General anesthesia respiratory effects

Hypoventilation Monitor patients who have received flumazenil for the reversal of benzodiazepine effects (after conscious sedation or general anesthesia) for resedation, respiratory depression or other residual benzodiazepine effects for an appropriate period (120 minutes or less) based on the dose and duration of effect of the benzodiazepine employed, because flumazenil has not been established as an effective treatment for hypoventilation due to benzodiazepine administration. Flumazenil may not fully reverse postoperative airway problems or ventilatory insufficiency induced by benzodiazepines. In addition, even if flumazenil is initially effective, such problems may recur because the effects of flumazenil wear off before the effects of many benzodiazepines. 

Administration Nalbuphine should be given as a supplement to general anesthesia only by persons specifically trained in the use of IV anesthetics and management of the respiratory effects of potent opioids. 

Finally, newer intravenous anesthetics such as etomidate (Amidate) and propofol (Diprivan) are available. Etomidate is a hypnoticlike drug that causes a rapid onset of general anesthesia with a minimum of cardiopulmonary side effects. Flence, this drug may be useful in patients with compromised cardiovascular or respiratory function. Propofol is a short-acting hypnotic that is useful as a general anesthetic in some... 

Tobias JD, Johnson JO, Sprague K, Johnson G. Effects of rapacuronium on respiratory function during general anesthesia a comparison with cis-atracurium. Anesthesiology 2001 95(4) 908-12. 

The use of MI-E has been demonstrated to be very important in extubating NMD patients following general anesthesia, despite their lack of any breathing tolerance, and managing them with NIV (8,9,60). It is also permitted to avoid intubation or to quickly extubate NMD patients in acute ventilatory failure with no breathing tolerance and profuse airway secretions due to intercurrent chest infections (37,83,84). MI-E in a protocol with manually assisted coughing, oximetry feedback, and home use of noninvasive intermittent positive pressure ventilation was shown to effectively decrease hospitalizations and respiratory complications, and mortality for patients with NMD (7,85). 

In 1958, phencyclidine (PCP) was introduced into clinical anesthesia as an injectable anesthetic agent. PCP had physiological properties that made it a useful anesthetic. The most significant of these was that it was quite effective but had no risk of cardiac or respiratory depression, as was typical of classical general anesthetic agents. 

---